Thirty-six patients who underwent major surgery were studied in order to clarify the perioperative changes in polymorpho - nuclear leukocyte (PMNL) function and serum opsonic activity. In patients without postoperative infection, the PMNL phagocytic-bactericidal capacity and plasma elastase levels significantly increased, while the serum opsonic index remarkably decreased just after surgery, however, all returned to the preoperative levels within 1 or 2 weeks. Conversely, in patients with postoperative infection, the PMNL bactericidal capacity and plasma elastase levels remained at high levels even after 1 or 2 weeks, while the PMNL phagocytic capacity and serum opsonic index substantially decreased after 2 weeks compared with the patients without postoperative infection. Plasma leukotriene B4, which is a potent chemo-attractant for PMNL, noticeably decreased in the patients with postoperative infection on the first postoperative day compared with that in the patients without postoperative infection. Our data suggests that the most important predisposing factors to postoperative infection may be a depressed PMNL phagocytic capacity and a lower serum opsonic activity after surgery, and that the increased PMNL bactericidal capacity and high plasma elastase levels during postoperative infection may contribute to the susceptibility to multiple organ failure.
The patient, an 83-year-old woman, visited another hospital with the complaint of hematemesis, and was diagnosed as having duodenal diverticular bleeding. She was transported to our hospital for further management, as the diverticulum perforated while she was undergoing endoscopic treatment.Abdominal computed tomography showed a hematoma and free gas around the perforation, which were thought to be caused by the perforated duodenal diverticulum, and emergency laparotomy was performed. Intraoperatively, hematoma, emphysema and inflammation were pronounced at the affected site. A perforated diverticulum was noted on the outside of the descending peduncle of the duodenum, which was resected at the site of the healthy intestinal wall using an automatic suture device.At the same operation, the gallbladder was removed and a drainage tube was placed in the cystic duct. After distal gastrectomy and postcolonic Roux-Y reconstruction (duodenal diverticulum), a drainage tube was placed retrogradely in the duodenal stump. The operation time was 3 hours 11 minutes.The postoperative course of the patient was satisfactory and she was discharged 16 days after the surgery.
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